Safety evalution of laparoscopic cholecystectomy guided by gallbladder ampulla localization on an imaginary clock for cholecystitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 SHANG Peizhong , MIAO Jianjun , LI Xiaowu , LIU Bing , WANG Jin , LÜ Ruichang , ZHANG Jinjiang , CAI Dawei , ZHAO Weinan , ZHANG Jie

Department of General Surgery, The 251st Hospital of PLA, Zhangjiakou, Hebei 075000, P. R. China;

Corresponding author：

SHANG Peizhong, Email: spz251@163.com

Keywords：

cholecystitis; cholecystolithiasis; cholecystectomy; laparoscope; bile duct injury; ampulla localization on an imaginary clock

DOI：

10.7507/1007-9424.201902057

Video：

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Objective To explore technical essentials and safety of laparoscopic cholecystectomy (LC) guided by gallbladder ampulla localization on an imaginary clock for cholecystitis.Methods A retrospective study of 8 707 continuous patients with mild cholecystitis who underwent LC from July 1998 to February 2018 at a single institution was conducted. Among them, 3 168 patients were treated by the traditional LC from July 1998 to February 2007 (a traditional LC group), 5 539 patients were treated by the LC with the guidance of the gallbladder ampulla localization on an imaginary clock from March 2007 to February 2018 (a gallbladder ampulla localization group). The conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding, bile leakage without bile duct injury, operative time, intraoperative blood loss, and postoperative hospital stays were compared between the traditional LC group and the gallbladder ampulla localization group.Results There were no significant differences in the gender, age, course of disease, and type of cholecystitis between these two groups (P>0.050). The rates of conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding, bile leakage without bile duct injury and the operative time, intraoperative blood loss and postoperative hospital stays in the traditional LC group were 3.00% (95/3 168), 0.13% (4/3 168), 0.09% (3/3 168), 0.03% (1/3 168), (43.6±12.6) min, (18.7±3.3) mL, (3.6±2.7) d, respectively, which in the gallbladder ampulla localization group were 0 (0/5 539), 0 (0/5 539), 0 (0/5 539), 0 (0/5 539), (32.2±10.5) min, (12.4±3.5) mL, (3.5±2.8) d, respectively. The differences of conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding rates, and the operative time and intraoperative blood loss were statistically significant between these two groups (P<0.050). The differences of the bile leakage without bile duct injury rate and postoperative hospital stays were not statistically significant between the two groups (P>0.050).Conclusion This study shows that gallbladder ampulla localization on an imaginary clock is useful for ductal identification so as to reduce bile duct injury and improve safety of LC in case of no conversion to open surgery.

Citation： SHANG Peizhong, MIAO Jianjun, LI Xiaowu, LIU Bing, WANG Jin, LÜ Ruichang, ZHANG Jinjiang, CAI Dawei, ZHAO Weinan, ZHANG Jie. Safety evalution of laparoscopic cholecystectomy guided by gallbladder ampulla localization on an imaginary clock for cholecystitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(7): 792-797. doi: 10.7507/1007-9424.201902057 Copy

1.	尚东, 张庆凯. 腹腔镜胆囊切除术胆管损伤的预防. 中华普通外科杂志, 2017, 32(8): 654-657.
2.	Hariharan D, Psaltis E, Scholefield JH, et al. Quality of life and medico-legal implications following iatrogenic bile duct injuries. World J Surg, 2017, 41(1): 90-99.
3.	李相成, 江王杰. 医源性胆管损伤分型及其意义. 中国实用外科杂志, 2018, 38(9): 985-988.
4.	刘希宁, 李英俊, 张瑞波, 等. 腹腔镜胆囊切除术中胆管损伤的处理方法探讨. 中华普通外科学文献(电子版), 2018, 12(6): 397-399, 404.
5.	Barrett M, Asbun HJ, Chien HL, et al. Bile duct injury and morbidity following cholecystectomy: a need for improvement. Surg Endosc, 2018, 32(4): 1683-1688.
6.	王红伟, 刘江伟, 康燕, 等. 微创保胆治疗1 008例胆囊息肉的临床及病理分析. 中国普外基础与临床杂志, 2018, 25(9): 1065-1070.
7.	尚培中. 胆囊结石腹腔镜治疗今日观. 解放军医药杂志, 2015, 27(11): 1-5.
8.	尚培中. 腹腔镜胆囊切除术中胆囊壶腹钟表定位法的研究及应用分析. 人民军医, 2017, 60(11): 1088-1091.
9.	尚培中. 胆囊壶腹钟表定位法对保障腹腔镜胆囊切除安全性的指导意义. 中华普外科手术学杂志(电子版), 2018, 12(1): 15-20.
10.	尚培中, 李晓武, 苗建军, 等. 应用壶腹钟表定位法缩短腹腔镜胆囊切除术学习曲线. 腹腔镜外科杂志, 2018, 23(7): 481-485.
11.	Wakabayashi G, Iwashita Y, Hibi T, et al. Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci, 2018, 25(1): 73-86.
12.	项建斌. 早期腹腔镜胆囊切除术治疗轻中型急性胆囊炎的临床研究. 中华普外科手术学杂志(电子版), 2019, 13(1): 54-56.
13.	彭一峰, 莫晔, 陈国斌, 等. 腹腔镜胆囊动脉入路与传统入路胆囊切除术的对比分析. 中华普外科手术学杂志(电子版), 2018, 12(2): 152-154.
14.	齐敦峰, 张昕辉, 李欢送, 等. 腹腔镜下左侧入路胆囊切除术在急性胆囊炎患者中的应用. 中国普外基础与临床杂志, 2017, 24(12): 1492-1495.
15.	李晓东, 刘山, 郑本波. 4种解剖标志帮助识别胆囊管避免胆管损伤(附316例报道). 中国普外基础与临床杂志, 2018, 25(9): 1121-1123.
16.	戴海粟, 陈志宇. 肝门部解剖变异与腹腔镜胆囊切除术中胆管损伤. 中华普通外科杂志, 2017, 32(8): 661-664.
17.	王蔚蓝, 吴伟, 吕永峰, 等. 腹腔镜胆囊切除术中变异胆囊动脉出血的预防与处理. 中国微创外科杂志, 2014, 14(6): 551-552.
18.	闫志文, 闫文举. 腹腔镜胆囊切除术中胆囊动脉出血的原因及防治措施. 医药论坛杂志, 2014, 35(12): 104-105.
19.	黄鑫, 洪建文, 詹泽锋, 等. 腹腔镜胆囊切除术中转开腹30例临床分析. 中华肝脏外科手术学电子杂志, 2014, 3(5): 276-278.
20.	孟凡盛, 庞晨, 高原, 等. 胆囊管和胆囊动脉的变异分型及影像辅助检查. 世界最新医学信息文摘(电子版), 2017, 17(99): 203-204.
21.	赵晓刚, 王德贵. 腹腔镜胆囊切除术中胆囊动脉的解剖观察. 临床医学研究与实践, 2016, 1(14): 89.
22.	Kunasani R, Kohli H. Significance of the cystic node in preventing major bile duct injuries during laparoscopic cholecystectomy: a technical marker. J Laparoendosc Adv Surg Tech A, 2003, 13(5): 321-323.
23.	张伟耀, 饶智, 潘磊. 胆囊淋巴结在腹腔镜胆囊切除术中的定位标志作用初探. 中国普外基础与临床杂志, 2014, 21(9): 1134-1137.
24.	哈恒勇, 陈文学, 李富荣. 腹腔镜" 一钩到底法”快速胆囊切除术的临床应用研究. 中华普通外科学文献(电子版), 2015, 9(4): 304-306.
25.	Strasberg SM, Pucci MJ, Brunt LM, et al. Subtotal cholecystectomy—" Fenestrating” vs " Reconstituting” subtypes and the prevention of bile duct injury: definition of the optimal procedure in difficult operative conditions. J Am Coll Surg, 2016, 222(1): 89-96.
26.	Stefanidis D, Chintalapudi N, Anderson-Montoya B, et al. How often do surgeons obtain the critical view of safety during laparoscopic cholecystectomy? Surg Endosc, 2017, 31(1): 142-146.

1. 尚东, 张庆凯. 腹腔镜胆囊切除术胆管损伤的预防. 中华普通外科杂志, 2017, 32(8): 654-657.
2. Hariharan D, Psaltis E, Scholefield JH, et al. Quality of life and medico-legal implications following iatrogenic bile duct injuries. World J Surg, 2017, 41(1): 90-99.
3. 李相成, 江王杰. 医源性胆管损伤分型及其意义. 中国实用外科杂志, 2018, 38(9): 985-988.
4. 刘希宁, 李英俊, 张瑞波, 等. 腹腔镜胆囊切除术中胆管损伤的处理方法探讨. 中华普通外科学文献(电子版), 2018, 12(6): 397-399, 404.
5. Barrett M, Asbun HJ, Chien HL, et al. Bile duct injury and morbidity following cholecystectomy: a need for improvement. Surg Endosc, 2018, 32(4): 1683-1688.
6. 王红伟, 刘江伟, 康燕, 等. 微创保胆治疗1 008例胆囊息肉的临床及病理分析. 中国普外基础与临床杂志, 2018, 25(9): 1065-1070.
7. 尚培中. 胆囊结石腹腔镜治疗今日观. 解放军医药杂志, 2015, 27(11): 1-5.
8. 尚培中. 腹腔镜胆囊切除术中胆囊壶腹钟表定位法的研究及应用分析. 人民军医, 2017, 60(11): 1088-1091.
9. 尚培中. 胆囊壶腹钟表定位法对保障腹腔镜胆囊切除安全性的指导意义. 中华普外科手术学杂志(电子版), 2018, 12(1): 15-20.
10. 尚培中, 李晓武, 苗建军, 等. 应用壶腹钟表定位法缩短腹腔镜胆囊切除术学习曲线. 腹腔镜外科杂志, 2018, 23(7): 481-485.
11. Wakabayashi G, Iwashita Y, Hibi T, et al. Tokyo Guidelines 2018: surgical management of acute cholecystitis: safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci, 2018, 25(1): 73-86.
12. 项建斌. 早期腹腔镜胆囊切除术治疗轻中型急性胆囊炎的临床研究. 中华普外科手术学杂志(电子版), 2019, 13(1): 54-56.
13. 彭一峰, 莫晔, 陈国斌, 等. 腹腔镜胆囊动脉入路与传统入路胆囊切除术的对比分析. 中华普外科手术学杂志(电子版), 2018, 12(2): 152-154.
14. 齐敦峰, 张昕辉, 李欢送, 等. 腹腔镜下左侧入路胆囊切除术在急性胆囊炎患者中的应用. 中国普外基础与临床杂志, 2017, 24(12): 1492-1495.
15. 李晓东, 刘山, 郑本波. 4种解剖标志帮助识别胆囊管避免胆管损伤(附316例报道). 中国普外基础与临床杂志, 2018, 25(9): 1121-1123.
16. 戴海粟, 陈志宇. 肝门部解剖变异与腹腔镜胆囊切除术中胆管损伤. 中华普通外科杂志, 2017, 32(8): 661-664.
17. 王蔚蓝, 吴伟, 吕永峰, 等. 腹腔镜胆囊切除术中变异胆囊动脉出血的预防与处理. 中国微创外科杂志, 2014, 14(6): 551-552.
18. 闫志文, 闫文举. 腹腔镜胆囊切除术中胆囊动脉出血的原因及防治措施. 医药论坛杂志, 2014, 35(12): 104-105.
19. 黄鑫, 洪建文, 詹泽锋, 等. 腹腔镜胆囊切除术中转开腹30例临床分析. 中华肝脏外科手术学电子杂志, 2014, 3(5): 276-278.
20. 孟凡盛, 庞晨, 高原, 等. 胆囊管和胆囊动脉的变异分型及影像辅助检查. 世界最新医学信息文摘(电子版), 2017, 17(99): 203-204.
21. 赵晓刚, 王德贵. 腹腔镜胆囊切除术中胆囊动脉的解剖观察. 临床医学研究与实践, 2016, 1(14): 89.
22. Kunasani R, Kohli H. Significance of the cystic node in preventing major bile duct injuries during laparoscopic cholecystectomy: a technical marker. J Laparoendosc Adv Surg Tech A, 2003, 13(5): 321-323.
23. 张伟耀, 饶智, 潘磊. 胆囊淋巴结在腹腔镜胆囊切除术中的定位标志作用初探. 中国普外基础与临床杂志, 2014, 21(9): 1134-1137.
24. 哈恒勇, 陈文学, 李富荣. 腹腔镜" 一钩到底法”快速胆囊切除术的临床应用研究. 中华普通外科学文献(电子版), 2015, 9(4): 304-306.
25. Strasberg SM, Pucci MJ, Brunt LM, et al. Subtotal cholecystectomy—" Fenestrating” vs " Reconstituting” subtypes and the prevention of bile duct injury: definition of the optimal procedure in difficult operative conditions. J Am Coll Surg, 2016, 222(1): 89-96.
26. Stefanidis D, Chintalapudi N, Anderson-Montoya B, et al. How often do surgeons obtain the critical view of safety during laparoscopic cholecystectomy? Surg Endosc, 2017, 31(1): 142-146.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Safety evalution of laparoscopic cholecystectomy guided by gallbladder ampulla localization on an imaginary clock for cholecystitis

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